Machado E S, Hofer C B, Costa T T, Nogueira S A, Oliveira R H, Abreu T F, Evangelista L A, Farias I F A, Mercadante R T C, Garcia M F L, Neves R C, Costa V M, Lambert J S
Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
Sex Transm Infect. 2009 Apr;85(2):82-7. doi: 10.1136/sti.2008.032300. Epub 2008 Nov 5.
The potential adverse effects of antiretroviral drugs during pregnancy are discrepant and few studies, mostly from Europe, have provided information about pregnancy outcomes of those already on treatment at conception. The aim of this study was to investigate the impact of antiretrovirals (ARVs) on pregnancy outcome according to the timing of treatment initiation in a cohort of pregnant women from Brazil infected with HIV.
A prospective cohort of 696 pregnant women followed up in one single centre between 1996 and 2006 was studied. Patients who had ARV treatment before pregnancy were compared with those treated after the first trimester. The outcomes evaluated were preterm delivery (PTD) (<37 weeks), severe PTD (<34 weeks), low birth weight (LBW) (<2500 g) and very LBW (<1500 g).
Patients who were using ARVs pre-conception had higher rates of LBW (33.3% vs 16.5%; p<0.001) and a similar trend for PTD (26.3% vs 17.7%; p = 0.09). Stratification by type of therapy (dual vs highly active antiretroviral therapy (HAART)) according to timing of initiation of ARVs showed that patients who use HAART pre-conception have a higher rate of PTD (20.2% vs 10.2%; p = 0.03) and LBW (24.2% vs 10.2%; p = 0.002). After adjusting for several factors, HAART used pre-conception was associated with an increased risk for PTD (AOR 5.0; 95% CI 1.5 to 17.0; p = 0.009) and LBW (OR 3.6; 95% CI 1.7 to 7.7; p = 0.001).
We identified an increased risk for LBW and PTD in patients who had HAART prior to pregnancy.
抗逆转录病毒药物在孕期的潜在不良反应存在差异，且大多来自欧洲的研究提供了关于受孕时已接受治疗者的妊娠结局信息。本研究旨在调查在巴西感染HIV的孕妇队列中，抗逆转录病毒药物（ARV）根据治疗开始时间对妊娠结局的影响。
对1996年至2006年在单一中心随访的696名孕妇进行前瞻性队列研究。将妊娠前接受ARV治疗的患者与孕早期后接受治疗的患者进行比较。评估的结局包括早产（PTD，<37周）、重度早产（<34周）、低出生体重（LBW，<2500g）和极低出生体重（<1500g）。
妊娠前使用ARV的患者低出生体重发生率更高（33.3%对16.5%；p<0.001），早产有类似趋势（26.3%对17.7%；p = 0.09）。根据ARV开始时间按治疗类型（双联疗法与高效抗逆转录病毒疗法（HAART））分层显示，妊娠前使用HAART的患者早产发生率更高（20.2%对10.2%；p = 0.03），低出生体重发生率更高（24.2%对10.2%；p = 0.002）。在对多个因素进行调整后，妊娠前使用HAART与早产风险增加相关（调整后比值比5.0；95%置信区间1.5至17.0；p = 0.009）和低出生体重相关（比值比3.6；95%置信区间1.7至7.7；p = 0.001）。
我们发现妊娠前接受HAART的患者低出生体重和早产风险增加。
